Citation Nr: 20004836 Decision Date: 01/22/20 Archive Date: 01/21/20 DOCKET NO. 17-01 380 DATE: January 22, 2020 ORDER The claim of entitlement to service connection for sleep apnea is withdrawn. The claim of entitlement to a compensable rating for right leg, cellulitis, is withdrawn. The claim of entitlement to a compensable rating for malaria is withdrawn. The petition to reopen the claim of entitlement to service connection for a liver condition as secondary to service-connected malaria, is allowed, the appeal is granted to that extent only. The petition to reopen the claim of entitlement to service connection for a kidney condition as secondary to service-connected malaria is allowed; the appeal is granted to that extent only. Entitlement to service connection for a liver condition, to include as secondary to service-connected malaria, is denied. Entitlement to service connection for a kidney condition (also claimed as a prostate condition), to include as secondary to service-connected malaria, is denied. Entitlement to service connection for diabetes mellitus is denied. Entitlement to a rating in excess of 30 percent for other specified trauma and stressor related disorder is denied. Entitlement to a compensable rating for bilateral hearing loss is denied. FINDINGS OF FACT 1. At his May 2019 Board hearing, prior to the promulgation of a Board decision on the appeal, the Veteran withdrew his appeals seeking entitlement to service connection for sleep apnea and compensable ratings for right leg cellulitis and malaria. 2. The Veteran did not appeal an August 1996 rating decision that denied the claims of entitlement to service connection for a liver condition and a kidney condition, and the decision became final. 3. Evidence received since the August 1996 rating decision is not cumulative or redundant of the evidence of record at the time of the prior final denial of the claims and raises a reasonable possibility of substantiating the claims of entitlement to service connection for a liver condition and a kidney condition. 4. The preponderance of the evidence of record is against finding that a liver disability was present at any time during or approximate to the pendency of the claim. 5. The preponderance of the evidence of record is against finding that a kidney disability was present at any time during or approximate to the pendency of the claim. 6. The preponderance of the evidence of record is against finding that diabetes mellitus was present at any time during or approximate to the pendency of the claim. 7. Throughout the period on appeal, the Veteran’s mental disorder more nearly approximates symptoms productive of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform tasks. 8. The Veteran’s bilateral hearing loss manifests, at worst, in Level I hearing impairment during the appeals period. CONCLUSIONS OF LAW 1. The criteria for withdrawal of an appeal by the Veteran have been met with respect to the issues of entitlement to service for sleep apnea and entitlement to compensable ratings for right leg cellulitis and malaria. 38 U.S.C. § 7105 (2012); 38 C.F.R.§§ 20.202, 20.204 (2018). 2. Since the August 1996 rating decision, new and material evidence has been received, and the claims of entitlement to service connection for a liver condition and a kidney condition are reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2018). 3. The criteria for service connection for a liver condition are not met. 38 U.S.C. § 5107; 38 C.F.R. § § 3.102, 3.303 (2018). 4. The criteria for service connection for a kidney condition are not met. 38 U.S.C. § 5107; 38 C.F.R. § § 3.102, 3.303 (2018). 5. The criteria for service connection for diabetes mellitus are not met. 38 U.S.C. § 5107; 38 C.F.R. § § 3.102, 3.303 (2018). 6. . The criteria for a rating in excess of 30 percent for other specified trauma and stressor related disorder are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.130, Diagnostic Code 9411. 7. The criteria for a compensable rating for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.85, 4.86, Diagnostic Code 6100 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1966 to October 1968. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). Duty to Assist As a preliminary matter, the Board notes the Veteran’s claims throughout the period on appeal that the VA has not met its duty in assisting him with the development of his claims. For instance, on his December 2016 Form 9, he reported that the VA has not made a good faith effort to study his condition and that they have ignored favorable laboratory findings relevant to his claims. He reports that during one of his examinations a VA examiner gave him a copy of a statement of the case (SOC) that she would later send to the RO. Moreover, he stated that he never saw a doctor to study his condition, and that the people who saw him were only filling-out answers to questions asked to him. At his May 2019 Board hearing, the Veteran contended that his last VA examination for his bilateral hearing loss was inaccurate but did not specify what about the examination was inaccurate. He also reported issues with the general VA system that affected his ability to get a primary care doctor and to see a doctor for inpatient treatment for his mental disorder. The Board notes that a precedential opinion regarding the competency of VA examiners has recently been issued by the United States Court of appeals for the Federal Circuit (Federal Circuit) in Francway v. Wilkie (No. 17-1821). In this case the Federal Circuit found that, once a Veteran has raised the issue of competency regarding a medical examiner, VA must satisfy its burden by providing the qualifications of the medical examiner. The Board does not find the preliminary requirement of raising the issue of competency has been adequately raised by the Veteran. As the Veteran has been afforded a VA examination for each of the claims, the Veteran’s complaints, are related to the adequacy of his examinations. As noted in Francway, the issue of an examiner’s competency versus the adequacy of a VA examination are two separate inquiries. Mathis v. McDonald, 834 F.3d 1347, 1351 (Fed Cir. 2016). The Board does not find that any issues of competency have been sufficiently raised with clarity. His assertions do not specifically report the issues of competency of any examiner for any specific examination he has been rendered. To the extent the Veteran claims the VA examinations he has had are inadequate, each examination relied on in-person inspection of the Veteran. The examinations cited specifics, such as dates of his previous labs, to support their findings. The Board finds these examinations are adequate for VA purposes. See Sickels v. Shinseki, 643 F.3d 1362, 1365-66 (Fed. Cir. 2011) (holding that, under the presumption of regularity in the administrative process, the Board is entitled to assume the adequacy of VA examinations and opinions absent specific evidence to the contrary). The Veteran has not provided any specific evidence that any of his examinations have been inadequate. The examinations are congruent with other medical evidence of record which reinforces the Board’s determination. Withdrawal The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105 (2018). An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204 (2018). Withdrawal may be made by the appellant or by his or her authorized representative. 38 C.F.R. § 20.204. In the present case, the Veteran testified, on the record, at his May 2019 Board hearing before the undersigned Veterans Law Judge that he wished to withdraw from appellate review his claims for entitlement to service connection for sleep apnea and for compensable ratings for right leg cellulitis and malaria. The Veteran was represented by a representative from Texas Veteran Commission at the time of the hearing it was noted he was informed of the consequences of the withdraw by his representative who also agreed to the withdrawal. As a result, there remain no allegations of errors of fact or law for appellate consideration with regard to these issues. Accordingly, the Board does not have jurisdiction over these issues, and the appeals are dismissed with respect to said issues. New and Material To reopen a previously and finally-disallowed claim, there must be new and material evidence presented or secured since the time that the claim was finally disallowed on any basis. 38 U.S.C. § 7104(b). In considering whether to reopen a claim, VA must assume the credibility of the aforementioned evidence which supports the Veteran’s claim as required by Justus v. Principi, 3 Vet. App. 510, 513 (1992) ([i]n determining whether evidence is new and material, “credibility” of newly presented evidence is to be presumed unless evidence is inherently incredible or beyond competence of witness.). New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In Shade v. Shinseki, 24 Vet. App. 110, 117 (2010), the Court of Appeals for Veterans Claims (Court) held that, when evaluating the materiality of newly submitted evidence VA should not limit its consideration to whether the newly submitted evidence relates specifically to the reason why the claim was last denied, but instead should consider whether the evidence could reasonably substantiate the claim were the claim to be reopened, including by triggering VA’s duty to obtain a VA examination. Id. at 118 Further discussion is provided below, however, as a general matter, the Board finds that the duty to assist has been met. 1. The petitions to reopen the claims for a liver condition and a kidney condition, are allowed, the appeals are granted to that extent only. The Veteran’s claims for service connection for a liver condition and kidney condition were denied by the RO in August 1996 because there was no kidney or liver condition present and there was no medical evidence linking the conditions to malaria. The Veteran did not file notice of disagreement nor did he submit material evidence within one year of this decision. As such, the decision became final. 38 C.F.R. §§ 20.200, 20.302. The Veteran filed an intent to file in February 2016 and a claim to reopen in March 2016. At the time of the previous denial, the record consisted of Service Treatment Records (STR’s) and VA medical records. Since the August 1996, VA medical records have been updated. The report of a VA examination in August 2018 referenced the presence of protein in the urine in July 2016 and January 2017. Subsequent urinalysis in May 20017 was normal. This evidence suggests a liver and/or kidney condition may have been present. This evidence is new, because it was not previous of record and it is “material” because it provides some evidence that the Veteran has a current disability for service connection purposes. The Board finds that new and material evidence has been received and the petitions to reopen these claims are granted. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303. “To establish a right to compensation for a present disability, a veteran must show: ‘(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service’ the so-called “nexus” requirement.” Holton v. Shineski, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). A veteran who, during active military, naval, or air service, served in the Republic of Vietnam between January 9, 1962 and May 7, 1975 is presumed to have been exposed to an herbicide agent if a listed chronic disease becomes manifest to a degree of 10 percent disabling or more, unless there is affirmative evidence to the contrary. 38 C.F.R. § 3.307. If a veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases are presumed to be service connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met, even though there is no record of the disease during service. 38 U.S.C. § 1116 (a); 38 C.F.R. § 3.309(e). 2. Entitlement to service connection for a liver condition and a kidney condition, to include as secondary to service-connected malaria, is denied. The Veteran reports that malaria and Agent Orange have caused a liver condition and a kidney condition. During service, he reports that his repeated exposure to contaminated drinking water and the overall environment has led to his current conditions. Moreover, at his May 2019 Board hearing he testified that, while he has never been diagnosed with a liver or kidney condition, he has these conditions based on laboratory findings and symptoms. In August 2018, the Veteran underwent VA examinations for his liver and kidney claims. The examiner determined that the Veteran did not have a liver condition and a kidney condition and one had never been diagnosed. There were no signs nor symptoms currently. It was noted the Veteran reported having a liver condition and kidney condition but he did not know what actual medical condition that he had been diagnosed with. While he reported previously having abnormal liver results, he denied currently being on any type of treatment for a liver condition. The examiner found that the diagnostic tests conducted as part of the examination were all normal. In the absence of proof of a present disorder (and, if so, of a nexus between that disorder and the active military service), there can be no valid claims for service connection. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Board finds that service connection is not warranted for a kidney and liver condition because these claims lack a current disability. To the extent the Veteran asserts that he had abnormal testing for his liver and kidneys in the past, the Veteran has not established, nor does the record indicate, that this testing has risen to the level of a current disability for service connection purposes. The term “disability” as used for VA purposes refers to impairment of earning capacity. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). The United States Court of Appeals for Veterans Claims (“the Court”) consistently has held that, under the law, “[a] determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or a disease incurred in service.” Watson v. Brown, 4 Vet. App. 309, 314 (1993). This principle has been repeatedly reaffirmed by the Federal Circuit Court, which has stated, “a Veteran seeking disability benefits must establish... the existence of a disability [and] a connection between the Veteran’s service and the disability.” Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). At his August 2018 VA examination, the examiner determined that the Veteran did not warrant a liver or kidney diagnosis. Moreover, there was no functional impact from any reported liver or kidney condition in the record. As noted, the Veteran denied any current treatment for a liver condition; nor did he indicate any current kidney conditions at his August 2018 VA examination. The Board has considered whether the Veteran experienced a liver or kidney condition at any time during the pendency of this appeal. Service connection may be granted if there is a disability at some point during the claim even if it later resolves or becomes asymptomatic. McClain v. Nicholson, 21 Vet. App. 319 (2007). Yet as it pertains to his liver claim, diagnostic testing on his August 2018 VA examination reported that his lab testing in October 2017 and February 2018 reported normal testing results for his liver condition. While the record indicates the Veteran had abnormal urine results in July 2016 and January 2017, in which high protein was found in his urine, the record does not indicate these abnormal results have risen to the level of a disability. Notably, the August 2018 VA examiner directly addressed these findings during the examination portion but concluded the Veteran has never had an official diagnosis of a kidney condition during the medical opinion portion of his examination. To that extent, the Board finds that service connection is not warranted. As these claims lack the cornerstone of every VA claim, further discussion is not warranted. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). 3. Entitlement to service connection for diabetes mellitus, type II, is denied. The Veteran alleges he has diabetes mellitus as a result of his service in Vietnam. As noted above, the Veteran may be presumed to have been exposed to an herbicide agent based on his service in Vietnam. The list of diseases associated with exposure to certain herbicide agents include Type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes). 38 C.F.R. § 3.309(e). Diabetes mellitus is also one of the listed chronic disease for which service connection may be presumed, if the chronic disease is shown as such during service or within one year of discharge from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.303(b), 3.307, 3.309. VA medical records do not include any competent diagnosis of diabetes. The claims record indicates the Veteran has been prediabetic since 2004. A VA examination was conducted in July 2016. At the examination, the examiner determined that the Veteran did not have a current official diagnosis of diabetes or that he had ever had a diagnosis of diabetes. The rationale reported was that the Veteran did not meet the criteria for a diabetes diagnosis as testing revealed normal Hgb A1C and fasting glucose. The examination reported as of April 2016, his A1C was 5.5 and his fasting plasma glucose was 89. In February 2018, the Veteran reported he had diabetes, but he did not take medication for the condition. It was recommended that he seek a primary care provider for the valuation of his condition. Upon review of the record, the Board concludes that the Veteran has not been diagnosed with diabetes mellitus as a current disorder at any time since the claim was filed in 2016. As discussed, the threshold requirement for service connection, including presumed service connection for a listed chronic disease or an herbicide-related disease, is a current disorder. See Degmetich v. Brown, 104 F.3d 1328 (1997); Brammer v. Derwinski, 3 Vet. App. 223 (1992). Without competent evidence of diabetes at any time during the period under review, service connection is not warranted. In the past the Court has observed that if VA examiners did not specifically state that the Veteran did not have a chronic disability at the time of filing a claim or afterwards, any Board determination that the symptoms of which he complained were acute and transitory, thus resolving without residual disability, constituted an unsupported medical determination in violation of Colvin v. Derwinski, 1 Vet. App. 171, 174 (1991). However, again, the July 2016 VA examination and the medical record clarifies that the Veteran has never had more than impaired glucose fasting and that it has never caused him to have any actual disabling effects. This is not a basis for granting service connection because compensation for disabilities due to service are limited to those have a disabling effect upon a veteran. The Board acknowledges the Veteran’s contentions that he has been told he has diabetes. He also reported at his May 2017 DRO hearing that he was previously told he was in a “stage of diabetes” and that the VA refused to do a test on the Veteran’s fingers for fear that it may show he had the diagnosis. Although the Veteran has indicated that he was told that he has diabetes, his clinical findings at his July 2016 VA examination outweigh his personal reports which are the lay interpretations of which the Veteran has not been found to be competent to make. The Board places greater probative value on the findings of the VA examiners who are medical professionals with pertinent training required to interpret the examination results. The examiners reviewed the pertinent medical tests of record and found that the Veteran did not have diabetes. In particular, a determination of whether the Veteran has diabetes mellitus is a medical question. The Veteran does not have the requisite training to be able to interpret the medical evidence and diagnosis diabetes mellitus. To the extent that the Veteran contends that the VA previously refused to conduct testing for his diabetes, the Board finds that this does not undermine the determination that he does not have a diagnosis of diabetes. As noted, the claims record continuously indicates the Veteran’s symptoms do not meet the threshold of a diagnosis of diabetes. The preponderance of the competent evidence of record is against this finding. The Veteran also contended that the etiology of his foot ulcers are due to his undiagnosed diabetes. No medical evidence has been received to confirm this lay opinion. The Board finds the diagnosis of diabetes mellitus and foot ulcers secondary to diabetes mellitus to be complex medical questions which a lay person is not competent to provide. The Veteran has not submitted competent evidence documenting that he has or had diabetes mellitus since the claim was filed. In conclusion, the Board finds that service connection is not warranted. As this claim lack the cornerstone of every VA claim, further discussion is not warranted. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). Increased Rating Disability evaluations are determined by the application of the facts presented to VA’s Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Where the question for consideration is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection and consideration of the appropriateness of a “staged” ratings are required. See Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). VA adjudicators must consider whether to assign different ratings at different times during the rating period to compensate the Veteran for times when the disability may have been more severe than at others. The Court since has extended this practice even to established ratings, not just initial ratings. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on the merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 4. Entitlement to a rating in excess of 30 percent for other specified trauma after February 23, 2016 is denied. The Veteran filed an intent to file on February 23, 2016, and he later filed a claim for increase for his mental disorder on March 4, 2016. In a July 2016 rating decision, he was granted an increase to 30%, effective the date of his intent to file, February 23, 2016. This appeal arises from his disagreement with this rating decision. The General Rating Formula for Mental Disorders, in pertinent part, provides for a rating of 30 percent if there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is assigned for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped, speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is assigned for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech that is intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, or for the veteran’s own occupation or name. 38 C.F.R. § 4.130, Diagnostic Code 9411 (2017). Evaluation under § 4.130 is symptom-driven, meaning that symptomatology should be the fact-finder’s primary focus when deciding entitlement to a given disability rating under that regulation. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116 -17 (Fed. Cir. 2013). In Vazquez-Claudio, the United States Court of Appeals for the Federal Circuit explained that the frequency, severity and duration of the symptoms also play an important role in determining the rating. Id. at 117. Significantly, however, the list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. 38 C.F.R. § 4.21; Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). If the evidence shows that the Veteran suffers symptoms listed in the rating criteria or symptoms of similar severity, frequency, and duration, that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the criteria for a particular rating, the appropriate equivalent rating will be assigned. Mauerhan, 16 Vet. App. at 443; see also Vazquez-Claudio, 713 F.3d at 117. As with all claims for VA disability compensation, the Board must assess the credibility and weigh all the evidence, including lay and medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Madden v. Gober, 125 F.3d 1477, 1481 (1997), cert. denied, 523 U.S. 1046 (1998). VA has recently changed its regulations, and now requires use of DSM-5 effective August 4, 2014. Among the changes, DSM-5 eliminates the use of the Global Assessment of Functioning (GAF) score in evaluation of psychiatric disorders. The change was made applicable to cases certified to the Board on or after August 4, 2014; and is not applicable to cases certified to the Board prior to that date. 79 Fed. Reg. 45093 (Aug. 4, 2014). This case was certified to the Board in August 2018. Therefore, the DSM-5 applies. Facts The medical evidence of record consists of reports of VA examinations. The Veteran has indicated he has not received mental health treatment during the appeal period. In June 2016, the Veteran underwent a VA examination in connection with this claim. A diagnosis of Other Specified Trauma-and Stressor-Related Disorder was made. The examiner found the Veteran no longer met the diagnostic criteria for a diagnosis of PTSD. The Veteran was widowed (since 2005) and lived with his father and a sister and brother. He got along well with his sisters but was not close to them. He got along well with his father. The Veteran reported he had no friendships since he moved from Denver to San Antonio in 2005. He was unemployed due to medical issues as he has a hard time walking. There was no history of legal or behaviour problems. It was the examiner’s opinion that the mental health condition symptoms were not severe enough to interfere with occupational and social functioning or to require continuous medication. At the examination, it was reported the Veteran had been unemployed since 2005 due to medical issues (i.e. issues with walking). Symptoms associated with the mental disorder were anxiety and chronic sleep impairment. At the time of the examination, the Veteran was alert, cooperative and pleasant. Affect was good as was comprehension. The examiner found that the Veteran did not meet the DSM-5 diagnostic criteria for PTSD and that other diagnostic criteria were barely met. The examiner determined the Veteran still had symptoms related to his service in Vietnam. The Veteran's main concerns were related to his general declining health which made it difficult for him to walk and he had minimal transportation service. As a result of this examination, the Veteran was increased to a 30 percent rating in a December 2016, with an effective date of February 23, 2016. At his May 2017 DRO hearing, the Veteran reported deficiencies in the VA staff regarding his treatment by a contracted psychologist. The Veteran underwent an additional VA examination in August 2018. A diagnosis of Other Specified Trauma-and Stressor-Related Disorder was made. The examiner found the symptoms associated with the mental disorder were productive of occupational and social impairment was with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. Symptoms associated with the mental disorder were depressed mood, anxiety, chronic sleep impairment, and mild memory loss. The Veteran reported he was not working at the time due to residuals of malaria and gout. He was living with his father and taking care of him. He did not have friends in town. He also lived with a brother and sister. His reported symptoms were depressed mood, anxiety, and chronic sleep impairment. Mental status examination revealed the Veteran was neat, casual, and hygiene was appropriate. He was friendly and cooperative during the entire session. His speech and volume were within normal limits. His thought process was goal directed and logical and there was no evidence of any thought disorder of audio-visual hallucinations. His mood was euthymic, and his affect was appropriate to mood and situation. He denied suicidal and homicidal ideations, intent and plan. He had no visible psychomotor agitation or noticeable psychomotor retardation. The Veteran’s insight was good, and his judgment was sound. He was able to understand the session’s contents for the entire examination period without noticeable fatigue or reduction in ability to respond appropriately to questions. It was opined that the Veteran no longer meets the DSM-5 criteria for PTSD, but he had some lingering depression and anxiety. His current diagnosis was an improvement from his previous PTSD diagnosis. He was experiencing mild symptoms associated with his disorder. At the Veteran’s Board hearing in May 2019, he reported symptoms of varying depression, fear, issues with sleeping, anger, difficulty with socializing, some panic attacks, and lack of motivation. The panic attacks were described as feeling a lot of tension and he did not know if they were actually panic attacks. He did not socialize much. He reported that he and a friend were different as they were in combat. Being different made him disappointed and angry. He reported difficulty with concentration. He testified that he did not have friends after moving out to Colorado as he didn’t know anyone. Analysis The medical evidence in the record does not support a finding that the Veteran’s PTSD disability warrants a rating in excess of 30 percent during the period on appeal. The weight of the evidence (including affirmative findings by two VA mental health professionals) shows that most of the Veteran’s symptoms are consistent with, at most, a 30 percent rating. With the exception of his self-reported tense episodes/ panic attacks at his May 2019 Board hearing, the Veteran’s symptoms are consistent with a 30 percent rating. While the Board acknowledges that the Veteran’s symptoms increased from the beginning of the appeals period from being depression and sleep impairment (June 2016), then also including anxiety (June 2018 VA examination), the severity of his symptoms more nearly approximate the 30 percent rating criteria. The Veteran has not been observed during the period on appeal to have a flattened affect or issues with his speech or mood. At his August 2018 VA examination, the VA examiner observed he was euthymic, and his affect was appropriate to mood and situation. Also, his speech and volume were reportedly within normal limits. While depression, anxiety, and lack of motivation have been reported, this is consistent with the enumerated rating criteria of a 30 percent rating. While he has reported he had disturbances in motivation and mood, the Board does not find this severity of this warrants an increase to a 50 percent rating. The objective observations from the two VA examiners on record do not indicate that his reported lack of motivation was so severe that his disorder manifested in reduced reliability and productivity. Moreover, in the context of determining whether a higher disability evaluation is warranted under Diagnostic Code 9411, the analysis requires considering “not only the presence of certain symptoms[,] but also that those symptoms have caused occupational and social impairment in most of the referenced areas” - i.e., “the regulation... requires an ultimate factual conclusion as to the Veteran’s level of impairment in ‘most areas.’” Vazquez-Claudio, 713 F.3d at 117-18; 38 C.F.R. § 4.130, Diagnostic Code 9411. Therefore, even taking his reports at face value, the record does not support a finding that these reported symptoms have caused occupational and social impairment with reduced reliability and productivity. The Veteran has testified as to what he describes as the panic attacks. He also reported issues with sleeping, anger, difficulty with socializing, and lack of motivation. To the extent that the symptomology reported by the Veteran is an actual panic attack, there is no indication that this is productive of any industrial impairment. The Veteran testified that he was dismissed from his last employment due to physical health problems and not mental health problems. There is no indication that the lack of motivation was productive of industrial incapacity. The Board have reviewed the Veteran’s contentions regarding the inadequacy of a contracted psychologist. These contentions were made during his May 2017 DRO hearing. However, the Veteran has been examined by two different VA examiners during this period on appeal. They both came to similar conclusions about his disability picture. As such, in spite of the Veteran’s contentions, the Board finds the Veteran’s symptoms have been adequately considered by the VA in its determination. In conclusion, the Board finds the Veteran’s disability picture more nearly approximates social and occupational impairment at a 30 percent rating during the entire appeal period. Therefore, the claim for increase of the rating is denied. 5. Entitlement to a compensable rating for bilateral hearing loss. The Veteran filed an intent to file on February 23, 2016. He later filed for an increase to his service-connected bilateral hearing loss in March 2016. He was denied an increase in a July 2016 rating decision. This appeal arises from his disagreement with this decision. Because the claim is not an initial claim, the Board will consider evidence of symptomatology up to one year from the date the claim was filed, the period beginning April 30, 2017. Hart v. Mansfield, 21 Vet. App. 505 (2007); 38 C.F.R. § 3.156(b). Evaluations of defective hearing range from noncompensable (zero percent) to 100 percent based on organic impairment of hearing acuity, as measured by the results of speech discrimination tests, together with the average hearing threshold levels as measured by Puretone audiometry tests in the frequencies 1,000, 2,000, 3,000, and 4,000 cycles per second (Hertz). To evaluate the degree of disability for service-connected hearing loss, the rating schedule establishes eleven auditory acuity levels, designated from Level I for essentially normal acuity through Level XI for profound deafness. 38 C.F.R. § 4.85. Examinations are conducted without the use of hearing aids. 38 C.F.R. § 4.85(a). Disability ratings for hearing impairment are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are rendered. See Bruce v. West, 11 Vet. App. 405, 409 (1998), quoting Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). In June 2016, the Veteran underwent a VA examination. The examination yielded the following puretone thresholds, in decibels: 500Hz 1000Hz 2000Hz 3000Hz 4000Hz Average Right Ear 25 30 40 45 45 40 Left Ear 20 25 40 60 60 46 The speech discrimination score revealed speech recognition ability of 92 percent in both ears. Under Table VI, the Veteran’s puretone threshold average and speech recognition ability corresponds with Level I both of his ears. This is consistent with a noncompensable percent rating. Later, he underwent an additional VA examination for his hearing in August 2018. The examination yielded the following Puretone thresholds, in decibels: 500Hz 1000Hz 2000Hz 3000Hz 4000Hz Average Right Ear 25 25 40 45 45 38.75 Left Ear 25 25 45 50 55 43.75 The speech discrimination score revealed speech recognition ability of 92 percent in both ears. Under Table VI, the Veteran’s Puretone threshold average and speech recognition ability corresponds with Level I both of his ears. This is, also, consistent with a noncompensable rating. There is no competent evidence of the presence of exceptional patterns of hearing loss so a rating pursuant to C.F.R. § 4.86 is not warranted. The Board has considered the Veteran’s lay statements concerning his hearing loss. The Veteran is competent to report his symptoms. Layno v. Brown, 6 Vet. App. 465 (1994). However, the Board finds that the objective measurements of hearing require specialized testing, and they fall outside the realm of common knowledge of a layperson and the Veteran is, thus, not competent to provide evidence on the issue of severity. See Jandreau v. Nicholson, 492 F.3d 1372, 1377, n.4; Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). As such, the VA examinations are more probative than the Veteran’s subjective complaints of increased symptomatology. The Board acknowledges the difficulties that the Veteran experiences as a result of his hearing loss. However, as explained above, the assignment of disability ratings for hearing impairment is derived by a mechanical application of the rating schedule to the numeric designation assigned after audiometry results are obtained. As such, the Board must predicate its determination on the basis of the audiology results of record. See Lendenmann v. Principi, 3 Vet. App. 345 (1992). Accordingly, the Board is bound by law to apply the VA’s rating schedule based on the Veteran’s audiometry results. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. As the preponderance of the evidence is against his claim, the provisions of 38 U.S.C. § 5107(b) regarding reasonable doubt are not applicable. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Therefore, the claim for increase is denied. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.Wade, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.